EMQ 1.A 4 year old child presents with a fit of coughing and choking. The symptoms have now resolved but the parents have noted a mid pitched whistling noise on both inspiration and expiration.

Answer: Foreign body aspiration.Comment: this is a typical history for an aspirated foreign body, and the biphasic nature of the stridor is highly suggestive.EMQ 2.A 6 year old boy presents with a high fever and difficulty breathing. He has notable tracheal tug and intercostal recession, and when he coughs his parents say it sounds like a seal barking.

Answer: CroupComment: this is a typical presentation of acute laryngotrachealbronchitis (croup) which should be evident to anyone sitting the fellowship exam.EMQ 3.A 16 year old boy presents with acute neck pain and fever. The symptoms have occurred rapidly over the preceding twelve hours, and he has a hoarse muffled voice. He describes severe odynophagia and cannot regularly swallow his own secretions.

Answer: acute epiglottitisComment: the rapidity of onset, odynophagia and muffled voice (a “hot potato voice”) are suggestive of epiglottic inflammation.EMQ 4. A 25 year old diabetic presents with a sore throat and high fever. He has had a sore throat for several days. He has severe torticollis and complains of pain when swallowing his secretions. He has no voice changes.On examination his vital signs are:HR 125/minBP90/60mmHgRR24/minTemp38.9oCAnswer: retropharyngeal abscessComment: the severe torticollis and impending sepsis favours a diagnosis of retropharyngeal abscess over simple tonsillitis or peritonsillar abscess.EMQ 5.A 14 year old boy presents with severe dyspnoea and distress. He had eaten a plate of prawns at a birthday party 30 minutes previously. He has severe inspiratory stridor on arrival to the ED.Answer: acute anaphylaxisComment: this is a classic history for anaphylaxis.